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ICD-9-CM Code

  • 738.4 Acquired spondylolisthesis

ICD-10-CM Code

  • M43.00 Spondylolysis, site unspecified

Preferred Practice Pattern1

Key Features

Description

  • Stress fracture of the pedicles on the vertebra below

  • Tightness or pain across the back region

  • Often no symptoms

  • Weakness in the pars

Essentials of Diagnosis

  • Diagnosis made by x-ray

  • Can be acquired or congenital

  • Back pain

General Considerations

  • Instability

  • Avoid extension positions that increase symptoms

  • Thin vertebral bone: pars

Demographics

  • Onset most often during teenage years

  • Runs in families

Clinical Findings

Signs and Symptoms

  • Back pain

  • Stiffness along spine

  • Pain in lumbar spine worsens with extension

Functional Implications

  • Difficulty maintaining standing postures secondary to back pain

  • Inability to sleep flat on back without a pillow

  • Difficulty with movements (bending over) secondary to pain

  • Limit sports participation

Possible Contributing Causes

  • Forceful extension as a result of a hit from behind (as in sports)

  • Congenital

  • Car accident, hit from rear

  • Hyperextension of the lumbar spine

  • Increased lordosis posture

Differential Diagnosis

  • Peripheral nerve impairment

  • Spinal tumor

  • Peripheral neuropathy

  • Paraspinal spasms

  • Degenerative disk disease

  • Stenosis

Means of Confirmation or Diagnosis

Imaging

  • MRI helps to visualize compressed or inflamed nerve root in diagnosis

  • X-ray/plain-film radiograph to see vertebra position

  • CT to show herniation compressing the spinal canal/nerves

  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

Findings and Interpretation

  • Stress fracture of the pars

Referrals/Admittance

  • To hospital for imaging

  • To physician for surgical consult if myelopathy suspected

    • Fusion

    • Decompression

    • Laminectomy

    • Hemilaminectomy

  • To physician for corticosteroid injection

  • To physician for anti-inflammatory medication

  • To orthopedist for lumbar bracing

Impairments

  • Restricted mobility of the lumbar spine

  • Hypermobility

  • Noted weakness noted of core musculature

Intervention

  • Rest

  • Bracing

  • Ergonomic training

  • Address pain

    • Electrical stimulation

    • Heat/ice

  • Address hypertonicity

    • Soft tissue massage

    • Heat

  • Address muscle weakness

    • Core stability exercises

Functional Goals

  • Patient will be able to

    • Sit with neutral lumbar spine posture for greater than 30 minutes with 0 out of 10 pain rating

    • Stand at work station and perform computer work for 45 minutes with 0 out of 10 pain rating

    • Rotate lumbar spine in order to lift/pick up items off the floor with 0 out of 10 pain rating

Prognosis

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